Is non-invasive management of dental caries in private practice cost-effective? A randomized controlled trial

尽管有相反的证据，牙医还是会定期补牙，如果采取预防措施，可能会修复（停止）蛀牙。这种做法可能给社会带来巨大的代价。模型表明，在一颗牙齿的生命周期内，每一次新的牙齿填充物可能平均花费1811美元。这一数字包括再治疗费用，以及将来更昂贵的再治疗的可能性增加，如根管治疗和牙齿冠。对所涉及的社会成本的审查可能会表明，这一数额被低估了；想想卫生部门以外的部门承担的成本：工作损失的天数、生产力损失。此外，我们应该考虑到家庭的成本：旅行时间和费用，儿童保育，为了支付牙科治疗而放弃的物品的机会成本。尽管如此，最近一项关于预防龋齿的系统综述得出的结论是，“目前没有证据表明，在已发表的经济评估中，预防龋齿措施的成本效益”。作者强调缺乏方法学上可靠的研究。这项研究将比较一个有针对性的预防计划，以标准护理在私人牙科诊所。在采用另一种办法之前，需要对效力和成本效益进行评估。正是通过这种评估，才能评估比较国的价值，并节省我们宝贵的保健费用。根治龋齿的手术方法（补牙）在教授和提供牙科护理的公立和私立机构中都根深蒂固。战略要素是将全科诊所提供的服务重新定位，以实现大幅减少钻牙需求的目标，同时最大化非侵入性再矿化方法的机会，这种方法已在体外、体内和小规模临床试验中成功证明。

Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the societal costs involved is likely to reveal this amount to be an under-estimate; consider the costs borne by sectors outside health: days lost to work, lost productivity. Further, we should consider costs to families: travel time and costs, childcare, the opportunity cost of items forgone in order to pay for the dental treatment. Despite this, a recent systematic review of dental caries prevention concluded 'there is presently no proof, in published economic evaluations of the cost-effectiveness of caries-preventive measures'. The authors highlighted a lack of methodologically sound studies. This research will compare a targeted preventive program to standard care within private dental practices. Prior to an alternative approach being introduced, an assessment of effectiveness and cost-effectiveness is needed. It is through such assessment that the value of the comparator can be assessed and our precious health dollars saved. The radical surgical approach (filling) that evolved to deal with the caries problem is entrenched in both public and private institutions that teach and deliver dental care. The strategic element is to reorient the services provided by general practices towards to goal of delivering a substantial reduction in the need to drill teeth, while maximizing the opportunity for a non-invasive remineralization approach that has been successfully demonstrated in in-vitro, in-vivo, and in small scale clinical trials.